Enhanced Wound Healing With Bioactive Glass

Dr. Lantis shares insight and background on their poster, "Enhanced Wound Healing With Bioactive Glass," which was presented as a poster at 2023 SAWC Fall in Las Vegas, Nevada.

 

Transcript

John Lantis, MD:

Hello, I'm John Lantis, vascular surgeon in New York City. This is a poster in regards to enhanced wound healing with bioactive glass. It will be presented at the fall SAWC Meeting 2023 in Las Vegas, Nevada.

My research team and myself have been interested in this new grouping of synthetic biomaterials, of which one is bioglass. This is a scaffold for tissue regeneration. It was originally used for bone growth. It has a large proportion of boron in it, but also has calcium and other appropriate occurring elements. However, it is synthetic in the sense that it's not a true biologic membrane. It's not an extracellular matrix from a xenograft, it is not an amniotic tissue, it is not a human-derived tissue.

So this resorbable, borate-based fiber is very much like almost what you would think of as insulation fiber as far as its size and consistency, although it breaks down a little bit more and can be layered. There are a large number of cations and anions available for the tissue. And I'm not really going to get into the mechanism of action of this product, but there will certainly be other posters I'm sure at the meeting in regards to this.

What was so interesting to us was we had access to this over the 2022-2023 academic year where my fellow, Dr. Horn, was very interested in limb salvage and tissue regeneration. And she and the rest of the team took an interest in patients who had had multiple applications of other products without good outcomes.

There are 8 patients with 1 chronic wounds. They were either DFUs or venous leg ulcers in this initial prospective case series. We did not have a control arm in this study, but all these patients have been assessed for venous or arterial insufficiency. All of these patients received appropriate offloading. If they were venous, they were getting appropriate, multi-layer compression. Veins had been repaired where possible, and patient's arterial inflow had been maximized.

There were no patients with a hemoglobin A1C greater than 12, although we did not have true inclusion, exclusion criteria. But I'm just giving you a background on the folks. The patients were seen weekly in the vascular office and were debrided only in the vascular office. And this product was only applied in the outpatient setting, although of course it can be applied in the operating room as well.

The product was applied, as you can see in these pictures, directly onto the wound. On top of that was covered with a non-stick mesh dressing. And then on top of that, what we think of as a simple collagen, which is fairly standard for all of our, whether we want to call them CTPs or camps or skin substitutes, but that's the same way we dress all of them. Weekly measurements, wound characteristics, and photos were gathered for all the patients up to 12 weeks.

So there are 4 patients, as noted, with the DFU, which were 5 wounds, and 4 patients with VLUs, which were 6 wounds. And the mean wound size starting was just under 9 centimeters. The mean wound area reduction after an average application of roughly between 4 and 5 applications was 43%, and 35% of this wound area reduction occurred in the first 4 weeks.

Please note that, again, all of these patients had had a minimum of 3 other advanced therapies that had not worked, and that's the most amazing part to us. Many of these had very good therapies that worked for most of our patients, but had not worked for them.

There was a greater percentage of wound area reduction for the diabetic foot ulcers than for the venous leg ulcers. Of note, the venous leg ulcers in general had been open much longer than the diabetic foot ulcers as well. None of the patients had any problems with tolerating the dressing.

So in general for us, you can see some most notable wound area reduction. If you take a look at the bottom right picture here on the poster, you'll see a gentleman who has had an open wound after ankle surgery for 13 years. He's had actually full-thickness skin grafts, he's had split-thickness skin grafts, and he has had multiple applications of various cellular tissue-based therapies. This was the first therapy that actually had taken this one large wound and moved it down to 2 much smaller wounds. The patient in the top left had had an open ulceration for over 2 years and had only gotten down to this size. Now you will note that we did treat some of these patients for multiple weeks.

So in closing, this is an easy to use, highly efficacious dressing that is well tolerated by the patients. We've not seen any negative outcomes as of yet, and we are looking forward to further possible prospective randomized trials.

Thank you for your attention, and I hope you enjoy the rest of the posters.